During Pregnancy and Offspring Adiposity in Mid-childhood Kai Ling - - PowerPoint PPT Presentation

Maternal Physical Activity Before and During Pregnancy and Offspring Adiposity in Mid-childhood

Kai Ling Kong, Ph.D., M.S.

Post-doctoral Associate

Division of Behavioral Medicine Department of Pediatrics School of Medicine and Biomedical Sciences State University of New York at Buffalo E-mail: kkong4@buffalo.edu

Note: for non-commercial purposes only

BACKGROUND – Impact of Maternal Physical Activity

Maternal Outcomes

Gestational Weight Gain

Fetal Outcomes

Birth Weight

Long-term Offspring Outcomes

Later Obesity

Observational:

• Clapp et al., 1995
• Haakstad et al., 2007
• Olson et al., 2003
• Stuebe et al., 2009

RCTs

• Polley et al., 2002
• Barakat et al., 2009
• Mottola et al., 2010
• Haakstad et al., 2011
• Phelan et al., 2011
• Kong et al., 2014

Observational:

• Owe et al., 2009
• Juhl et al., 2010
• Mudd et al., 2012

RCTs:

• Clapp, 2000
• Santos et al., 2005
• Barakat et al., 2009
• Hopkins et al., 2010
• Haakstad et al., 2011
• Kong et al., 2014

Observational:

• Clapp et al., 1996
• Clapp, 1998
• Mattran et al., 2011

RCTs:

• Kong et al., 2014

BACKGROUND – Previous Research on Maternal

Physical Activity and Childhood Obesity

• Four known studies (n = 23 – 104)
• Ages:
• 6 months (Kong et al., 2014)
• 12 months (Clapp et al., 1998)
• 18 to 24 months (Mattran et al., 2011)
• 5 year (Clapp, 1996)
• Overall results:
• Null to low inverse association (Kong et al., 2014; Clapp et al., 1998; Mattran et al., 2011)
• Significant inverse association (Clapp, 1996)
• Limitation: Measure of adiposity (i.e. Ponderal Index, skinfold

thicknesses )

AIM 1:

Leisure time physical activity before and during pregnancy Offspring adiposity

• utcomes in

mid-childhood measured by dual-energy X- ray absorptiometry (DEXA) Change in leisure time physical activity before and during pregnancy

AIM 2:

METHODS

Pre-birth cohort

• n = 2,128
• Established Aug 1999
• Harvard Vanguard Medical Associates
• Massachusetts, USA

Pre-pregnancy PA (n = 1,683) Pregnancy PA (n = 1,620) DXA measures (n = 735) DXA measures (n = 718) Mid-childhood 7-10 year old

Exposures: Maternal total leisure time physical activity (LTPA)

• Pregnant women self-reported their activities
• Pre-pregnancy: initial visit reported 12 months before pregnancy
• Mid-pregnancy: mid-pregnancy visit reported preceding 3 months
• 3 classes of LTPA: walking, light-to-moderate, and vigorous
• Total LTPA = (walking) + (light-to-moderate) + (2x vigorous)*
• Change in LTPA = (mid-pregnancy PA) – (pre-pregnancy PA)

*2008 U.S. Physical Activity Guidelines for Americans

Outcomes: Mid-childhood overall and central adiposity

• Height and weight measurements
• Whole body dual-energy X-ray absorptiometry

(DEXA) (Hologic, Bedford, MA)

• Overall- Total fat mass index (FMI)
• Central- Truncal fat mass index (TFMI)
• Formula: [FMI (or TFMI) in kg]/(height in meters)²

Potential confounders

• Maternal race/ethnicity, education, age at

enrollment, pre-pregnancy BMI, marital status, smoking status, mid-pregnancy total energy intake, annual household income

• Paternal BMI (reported by mothers)
• Child’s birth weight, gestational age and sex

Data analysis

• LTPA reported as categorical and continuous

variables in hours/week

• Multivariable linear regression models to examine

associations, adjusting for confounders

• Confounders selection- based on >10% change in

beta after adding a confounder

RESULTS

Table 1. Sample characteristics

Table 1. Sample characteristics cont.

Table 1. Sample characteristics

Maternal physical activity and offspring FAT mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status

Maternal physical activity and offspring FAT mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status

Maternal physical activity and offspring TRUNCAL fat mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status

CHANGE in physical activity and offspring FAT mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status Model 3: pre-pregnancy leisure time physical activity

CHANGE in physical activity and offspring FAT mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status Model 3: pre-pregnancy leisure time physical activity

CHANGE in physical activity and offspring TRUNCAL fat mass index

Model 1: child age of DXA measures, gender Model 2: maternal race/ethnicity, education, age, pre- pregnancy BMI, marital status, and smoking status Model 3: pre-pregnancy leisure time physical activity

CONCLUSIONS

• U.S. pre-birth cohort- White, married and high socio-

economic status pregnant women

• Maternal physical activity were not associated with
• ffspring overall and central adiposity in mid-childhood.
• Maintained or increased physical activity during

pregnancy was not associated with lower mild-childhood adiposity.

• Other benefits of maternal physical activity (i.e. pre-

eclampsia, gestational diabetes, low back pain)

• Relatively large sample size (n = 700+) with long-term

follow-up

• Included pre-pregnancy physical activity change from

pre-pregnancy to pregnancy

• Research-quality of measures DXA adiposity measures.

Strengths Limitations

• Self-reported physical activity.
• Only one time point of PA measurements during pregnancy
• No report on occupational physical activity

ACKNOWLEDGMENT

• Co-authors
• Matthew Gillman, Sheryl Rifas-Shiman and Xiaozhong Wen
• Project Viva research team and participants
• The Power of Programming 2014 organizing

committee

CONFLICT OF INTEREST

All authors declare no conflicts of interest.

E-mail: kkong4@buffalo.edu

Questions or comments?

SUPPLEMENTAL MATERIALS

Maternal physical activity and offspring LEAN mass index

CHANGE in physical activity and offspring LEAN mass index

Compared to excluded women:

slightly older [mean, 32.2 (SD, 5.3) y vs. 31.6 (5.2) y], slightly longer gestational age at delivery [39.6 (1.7) weeks vs. 39.3 (2.1) weeks] heavier at birth [3505 (547) g vs. 3434 (617) g] more educated (% graduate, 34.5 % vs. 26.2 %), higher in white race (69.8% vs. 64.5%), higher in household income (% > $70000, 64.8% vs. 58.7%), higher in female infants (51.3% vs. 46.8%) lesser in women who smoked during pregnancy (9.4% vs. 14.6%).